Herpes Labialis Research Articles

First results from the RedirecTT-1 study with teclistamab (tec) + talquetamab (tal) simultaneously targeting BCMA and GPRC5D in patients (pts) with relapsed/refractory multiple myeloma (RRMM).

8002 Background: Tec is the first BCMA-directed bispecific antibody approved for the treatment of triple-class exposed RRMM. Tal, a bispecific antibody targeting the novel myeloma antigen GPRC5D, has shown promising efficacy in pts with RRMM. Simultaneously targeting 2 validated myeloma target antigens, using tec + tal in combination may lead to improved outcomes by overcoming resistance mechanisms, such as antigen escape. Here, we report the first results from the phase 1b RedirecTT-1 trial (NCT04586426) in pts with RRMM. Methods: Enrolled pts had MM per International Myeloma Working Group 2016 criteria; were RR or intolerant to the last line of therapy (LOT); were exposed to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 therapy; and had measurable disease. The primary objectives are to evaluate safety and to identify a recommended phase 2 regimen (RP2R) for the combination. Responses were investigator assessed. AEs were graded per CTCAE v5.0. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were graded per ASTCT criteria. Results: As of Dec 12, 2022, 63 pts received tec + tal. Median (range) age was 67 y (39–81); median (range) prior LOT was 5 (1–11); 33% (15/45) had high-risk cytogenetics; 78% (49/63) were triple-class refractory; 63% (40/63) were penta-drug exposed; and 43% (27/63) had extramedullary disease (EMD; all bone independent). Median (range) duration of follow-up was 14.4 mos (0.5–21.9). The most common treatment-emergent AEs were CRS (81%; grade [gr] 3, 3%, no gr 4), neutropenia (76%; gr 3/4, 75%), and anemia (60%; gr 3/4, 43%). Dose-limiting toxicities (DLTs) were reported at dose level 1 (gr 3 herpetic stomatitis) and dose level 3 (gr 3 AST/ALT elevation). One ICANS event was reported at dose level 3. No DLTs were reported at the RP2R. Across all dose levels, overall response rate (ORR) was 84% (52/62) among all evaluable pts and 73% (19/26) among evaluable pts with EMD; rate of CR or better (≥CR) was 34% (21/62) and 31% (8/26), respectively. At the RP2R, ORR was 92% (12/13) among all evaluable pts and 83% (5/6) among evaluable pts with EMD; rate of ≥CR was 31% (4/13) and 33% (2/6), respectively. Median duration of response has not been reached. Updated data, with 19 additional pts at the RP2R, will be presented. Conclusions: In this first combination study of a BCMA- and GPRC5D-targeted bispecific antibody, tec + tal at the RP2R has a manageable safety profile consistent with each of the monotherapies. A 92% ORR was observed in pts with advanced RRMM at the RP2R, and an ORR of 83% was achieved in pts with EMD, a high-risk population with unmet need, supporting further evaluation of the combination. Clinical trial information: NCT04586426 .

Metabolic profiles in plasma of patients with herpes labialis based on GC-MS.

This study aims to compare the plasma metabolic profiles of patients with herpes labialis with healthy controls and identify the biomarkers of herpes labialis. We collected 18 patients with herpes labialis and 20 healthy individuals. Plasma samples from both groups were analyzed using gas chromatography-mass spectrometry (GC-MS). According to the principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA), we found that metabolic profiles had changed in patients with herpes labialis compared to the controls. By further selecting the different metabolites according to the variable importance in the projection (VIP) and p valve of t-tests, we found that acetic acid, pyroglutamic acid, alanine, ethanedioic acid, cyclohexaneacetic acid, pyruvic acid, d-mannose, phosphoric acid, l-amphetamine, and citric acid were decreased in patients with herpes labialis, while sedoheptulose and ethylamine were increased. Pathway analysis showed that herpes labialis may affect the amino acid and energy metabolism. Our findings may contribute to elucidating the metabolic basis of herpes labialis and provide a new perspective for further research on the "Shang-Huo" state in traditional Chinese medicine (TCM).

54 Prophylactic Antibiotics are Unnecessary for Routine CO2 Laser Burn Scar Treatment

Abstract Introduction Many providers utilize prophylactic cephalexin prior to Co2 ablation laser for hypertrophic scarring. Many providers use this as standard of treatment despite a paucity of high-quality literature supporting the practice. The purpose of this study is to report a single-center experience in performing laser-assisted delivery of triamcinolone and destruction of burn scars without the use of antibiotics. Methods This was a retrospective descriptive study from a single center with a new laser scar program. The first 14 patients received cephalexin 500mg by mouth every 6 hours starting the day of the procedure for 5 days and valaciclovir 1000mg by mouth daily for 5 days for their first two procedures- as per manufacturer recommendations. After that, cephalexin was no longer utilized nor were any antibiotics given at the start time of procedure. Valacyclovir is given on a case-by-case basis for patients with a history of cold sores, known herpes simplex, or extensive facial procedures. Burn team staff members followed up with the patients within 48 -72 hours by phone call. Burn staff called patients after each laser treatment to assess for any adverse reactions. Adverse reactions include open areas, rashes, or blisters to laser site. The two groups were compared with a Fisher’s exact test for number of infections. Results Patients who received cephalexin accounted for the first 28 cases and none developed an infection. In 201 cases without antibiotics, only one patient developed cellulitis (0.5%), p=1. This patient was noncompliant with restrictions on hand hygiene and used a cheap lotion with parabens, dyes, and perfumes on post operative day 2. Another patient experienced a self-limiting dermatitis on their back of uncertain etiology. In 36 cases, valacyclovir was given. None of the patients in either group developed vesicular lesions consistent with HSV. Conclusions There were no significant differences in number of infections whether patients treated with or without prophylactic antibiotics before laser treatment of hypertrophic burn scars. The authors continue to treat patients without administering prophylactic antibiotics. Applicability of Research to Practice laser programs are common in burn centers

What is known about the diagnosis and treatment of herpes labialis?

Herpes labialis is one of the most common skin infections. In most people it is asymptomatic or mildly symptomatic, but very severe cases do occur. Herpes remains latent and can recur. Herpes labialis is a clinical diagnosis. If in doubt, additional testing can be carried out, usually polymerase chain reaction. There are no treatments that can eliminate the virus. In case of more severe symptoms and frequent recurrences, there may be an indication for treatment. In case of mild complaints, topical zinc sulphate/zinc oxide and analgesics (systemic or topical lidocaine) will suffice. More severe complaints and frequent recurrences can be treated with antiviral creams (Aciclovir) or with systemic antiviral medication (Valaciclovir). In frequent recurrences, prophylactic Valaciclovir can also be given for a period of many months. Treatment should be started as soon as possible and will slightly shorten the duration of the disease.

Tralokinumab shows clinical improvement in patients with prurigo nodularis-like phenotype atopic dermatitis: A multicenter, prospective, open-label case series study

There are several phenotypes of atopic dermatitis (AD). 1 Girolomoni G. de Bruin-Weller M. Aoki V. et al. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis. 2021; 2620406223211002979 Google Scholar The prurigo nodularis (PN)-like phenotype occurs in nearly one-half of the patients with AD. 1 Girolomoni G. de Bruin-Weller M. Aoki V. et al. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis. 2021; 2620406223211002979 Google Scholar In all AD phenotypes, chronic itch usually leads to an itch-scratch cycle with the development of secondary lesions. These include, in the PN-like phenotype, excoriated hyperkeratotic, intensely itchy papules and nodules in areas accessible to scratch. 1 Girolomoni G. de Bruin-Weller M. Aoki V. et al. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis. 2021; 2620406223211002979 Google Scholar An emergent role of the type 2 cytokines, including interleukin (IL) 4, IL-13, IL-31, and IL-5, has been suggested in the pathogenesis underlying AD itch. IL-13 is a potent enhancer of the neuronal response to different itch stimuli. 2 Miron Y. Miller P.E. Hughes C. et al. Mechanistic insights into the antipruritic effects of lebrikizumab, an anti–IL-13 mAb. J Allergy Clin Immunol. 2022; 150: 690-700 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Tralokinumab, a fully human IgG4 monoclonal antibody neutralizing IL-13, is a novel treatment that has demonstrated safety and efficacy in clinical trials in treating adult patients with moderate-to-severe AD. 3 Wollenberg A. Blauvelt A. Guttman-Yassky E. et al. Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2). Br J Dermatol. 2021; 184: 437-449 Crossref PubMed Scopus (170) Google Scholar In our open-label, retrospective case series study, tralokinumab improved clinical manifestations in 2 patients presenting with PN-like phenotype. 4 Pezzolo E. Naldi L. Tralokinumab in the treatment of resistant atopic dermatitis: an open-label, retrospective case series study. J Eur Acad Dermatol Venereol. 2023; 37: e644-e645 Crossref Scopus (2) Google Scholar Therefore, we prospectively investigated tralokinumab efficacy and safety in treating for at least 16 weeks, 17 adult patients with moderate-to-severe PN-like phenotype AD at 5 dermatology tertiary referral centers, from July 2021 to November 2022. Patients were eligible for treatment with tralokinumab after failing the first-line approved biologic treatment dupilumab, without achieving eczema area and severity index (EASI)-50 after 16 weeks of treatment. Written informed consent was obtained for each patient. At baseline, patients (mean age, 60.75 years; 76.5% women) presented moderate-to-severe PN-like phenotype AD and with means (ranges) EASI of 27.2 (16-45), Investigator Global Assessment (IGA) of 3.7 (3-4), numeric rating scale (NRS)-itch of 9.8 (8-10), NRS-sleeplessness of 8.9 (6-10), and dermatology life and quality index (DLQI) of 16.3 (14-24). Seventy percent of patients used concomitant topical corticosteroids at baseline. Patients reached EASI-50 within 4 weeks, EASI-75 within 12 weeks, and EASI-90 within 32 weeks (mean EASI reduction from 27.2-1.7, P <.001) (Fig 1). The mean NRS-itch and sleeplessness and DLQI values significantly decreased as early as week 4 (P <.001) and progressively reduced after 16-week continuous treatment. Tralokinumab resulted in complete or almost complete clinical remission (IGA 0 or 1) in 76% (13/17) of patients, in 47% (8/17) within week 12, in 23% within week 32, and 6% within week 64, and an at least 2-grade IGA reduction in the others (24%) (Fig 2). Both patients with 16-weeks treatment observation (8/17) and patients with 32 or 64 weeks of continuous treatment (9/17) maintained clinical efficacy without reporting any serious adverse effect. 5 Licata G, Tancredi V, Pezzolo E, et al. Efficacy and safeness of tralokinumab in patients with atopic dermatitis who developed conjunctivitis under dupilumab: a case series. J Eur Acad Dermatol Venereol. Published online April 5, 2023. https://doi.org/10.1111/jdv.19108 Google Scholar Mild conjunctivitis represented the main adverse effect (12%), followed by injection-site reaction, localized urticaria, and mild herpetic stomatitis. Fig 2Atopic dermatitis severity assessed by the Investigator Global Assessment score at different times. IGA, Investigator Global Assessment. View Large Image Figure Viewer Download Hi-res image

Deep learning-based common skin disease image classification

Skin disease is currently considered to be one of the most common diseases in the globe. Most of the human population has experienced it at some point but not all skin illnesses are as severe as others. There are some diseases that are symptomless or show fewer symptoms. Skin cancer is a potentially fatal outcome of serious skin illnesses that might develop if they are not detected in time. Due to the fact that medical professionals aren’t always quick or reliable enough to make a proper diagnosis. There is a hefty price tag attached to employing sophisticated equipment. Therefore, we propose a system capable of classifying skin diseases using deep learning approaches, such as CNN architecture and six preset models including MobileNet, VGG19, ResNet, EfficientNet, Inception, and DenseNet. Acne, blisters, cold sores, psoriasis, and vitiligo are some of the most often seen skin conditions, thus we scoured the web resources for relevant photographs of these conditions. We have applied data augmentation methods to extend the size of the dataset and include more image variations. In the validation dataset, we achieved an accuracy rate of approx 99 percent, while in the test dataset; we achieved an accuracy rate of approx 90 percent. Our proposed method would help to diagnose skin diseases in a faster and more cost-effective way.

HSV-1 and HHV-6 Meningoencephalitis in a Child with STAT1 Mutation

Introduction: STAT1 is a critical signal transducer for both the interferon gamma receptor and IFN-alpha/beta receptors and is required for responses to herpesviruses. STAT1 defects vary in severity and clinical presentation. STAT1 loss of function (LOF) mutations with Mendelian Susceptibility to Mycobacterial Disease (MSMD) and STAT1 gain of function (GOF) mutations have been described with a wide clinical spectrum, including nontuberculous mycobacteria, disseminated fungal, bacterial, and viral infections in addition to immune dysregulation. We present a 10-year-old female with HSV-1 and HHV-6 meningoencephalitis that was found to have a variant in STAT1. MethodsRetrospective chart review was conducted. Laboratory investigations included lymphocyte immunophenotyping by flow cytometry, lymphocyte proliferation to mitogens and antigens, NK cell functional assays, quantitative immunoglobulins, toll like receptor function defects, genetic evaluation by next generation sequencing, and assays for further evaluation for MSMD, T helper IL17, STAT GOF. ResultsA previously healthy 10-year-old Caucasian female presented with fever, headache, and new-onset seizure with status epilepticus. She was diagnosed with HSV-1 and HHV-6 meningoencephalitis, as CSF PCR panel was positive for HSV-1 and HHV-6. Brain MRI showed findings compatible with HSV-1 encephalitis. She was treated with a 14-day course of acyclovir with no noted neurological sequelae. Infection history was unremarkable except for one episode of otitis media as a child and a couple upper respiratory viral illnesses. Denied prior history of HSV infection. No family history of immunodeficiency disorders. Both parents reported remote history of herpetic gingivostomatitis. Laboratory immune evaluation was remarkable for decreased lymphocyte proliferative response to Candida antigen. Next generation sequencing revealed a variant of uncertain significance in STAT1 (c.295A>G; p.Ile99Val) and did not detect TLR3 or UNC93B1 mutations. ConclusionThe clinical phenotype caused by STAT1 mutations is highly diverse, and there is overlap between GOF and LOF phenotypes, making it difficult to clinically diagnose. Although HSV gingivostomatitis has been reported in a patient with STAT1 GOF, invasive disease, such as meningoencephalitis, has not been reported in those with variants in STAT1.

Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV), and Cryptococcal Infections Associated With Sphingosine-1-Phosphate Receptor (S1PR) Modulators: A Review (P12-10.005)

<h3>Objective:</h3> To summarize the existing data on the incidence of herpes simplex virus (HSV), varicella-zoster virus (VZV), and Cryptococcus sp. infections with sphingosine-1-phosphate receptor (S1PR) modulators. <h3>Background:</h3> S1PR modulators are a novel class of disease-modifying therapies for multiple sclerosis (MS) that produce immunosuppression and potential lymphopenia. Herpesvirus and cryptococcal diseases were the most common opportunistic infections in clinical trials. Several post-hoc analyses have subsequently been published with revised incidence rates (IRs) for these conditions. <h3>Design/Methods:</h3> A literature review and descriptive analysis of phase-3 trials (n=6), post-marketing studies (n=8), and case reports (n=17) were conducted using PubMed and Google Scholar. Further data was accessed through Novartis AG, Bristol-Myers Squibb, and Janssen Pharmaceuticals. <h3>Results:</h3> <h3>FINGOLIMOD:</h3> Herpesvirus infection rates were similar between placebo (2.8%) and 0.5 mg (2.1%) but increased with 1.25 mg (5.5%) in the TRANSFORMS study. VZV rates were higher with fingolimod 0.5 mg (3.0%; 11 per 1000 patient-years [PY]) than with placebo (1.0%; 6 per 1000 PY), but comparable post-marketing. Cryptococcal infections (n=74) had an IR of 9 per 100,000 PY, and 13 cases were individually reported. <h3>SIPONIMOD:</h3> VZV reactivation occurred more frequently with siponimod (2%) than with placebo (1%); EXPAND extension analyses calculated an IR of 0.9 for HSV and 1.8 for VZV infections. One case of cryptococcal meningitis (from 7236 PY of exposure) was documented. <h3>OZANIMOD:</h3> An integrated safety analysis reported oral herpes at 1.5%, VZV at 1.4%, and HSV at 0.5% from all clinical trials versus 0.7%, 0.6%, and 0.1% from the phase-3 trials. The IR of herpes zoster was 5.3/1000 PY. <h3>PONESIMOD:</h3> The incidence of herpetic infections was equal between both groups (4.8%) in the OPTIMUM trial. Cryptococcal infections have not yet been reported with ozanimod or ponesimod. <h3>Conclusions:</h3> Overall, the incidence of these opportunistic infections associated with S1PR modulators in MS was low, with favorable outcomes and limited fatalities. <b>Disclosure:</b> Dr. Sharma has nothing to disclose. Mr. JHA has nothing to disclose. Dr. Khanal has nothing to disclose. Dr. Sriwastava has nothing to disclose.

Vitamin D serum level in participants with positive history of recurrent herpes labialis

AimVitamin D plays an important role in immune system regulation, also its deficiency is assumed to affect the patients’ predisposition to viral diseases such as recurrent herpes labialis. In this cross-sectional study, we tried to compare the mean serum level of vitamin D in participants with a positive history of recurrent herpes labial lesions and healthy controls.Materials and methodsThe vitamin D serum level of 43 participants with a positive history of recurrent herpes labial lesions who were referred to the Motahhari laboratory in Shiraz during 2020–2022, was compared with 42 healthy controls. It was assessed by an Elisa kit. An Independent T-test was used to compare the vitamin D serum level between two genders. In order to assess the mean age value and gender distribution, an independent T-test and Pearson Chi-Square were used, respectively for the two groups. The serum vitamin D level was compared between both control and test groups.ResultsThere was no significant difference between vitamin D mean serum levels in the two evaluated groups (p.value = 0.72). Although the age (p.value = 0.09) and recurrence (p.value = 0.13) of herpes labialis had no statistically significant relation to the vitamin D serum level, the healing duration of herpes labialis was inversely related (p.value = 0.01). Lower-level of serum vitamin D were accompanied by a longer healing duration of the lesions.ConclusionAlthough the vitamin D serum level of participants with a history of recurrent herpes labialis had no relation with age and herpes virus recurrence frequency, a longer healing duration of lesions had been reported in patients with lower serum levels of vitamin D.

Controlling viral inflammatory lesions by inhibiting fatty acid metabolism

Herpes simplex virus infection is a major cause of vision loss in humans. Eye damaging consequences are often driven by inflammatory cells as a result of an immune response to the virus. In the present report, we have compared the effect of inhibiting energy metabolism with etomoxir (Etox), which acts on the fatty acid oxidation pathway and 2-Deoxy-d-glucose (2DG), which acts on glycolysis for their inhibitory effects on herpetic ocular lesions. Both drugs showed similar protective effects when therapy was started on the day of infection, but some 2DG recipients succumbed to encephalitis. In contrast, all Etox recipients remained healthy. Both drugs were compared for effects on inflammatory reactions in the trigeminal ganglion (TG), where virus replicates and then establishes latency. Results indicate that 2DG significantly reduced CD8 and CD4 Th1 T cells in the TG, whereas Etox had minimal or no effect on such cells, perhaps explaining why encephalitis occurred only in 2DG recipients. Unlike treatment with 2DG, Etox therapy was largely ineffective when started at the time of lesion expression. Reasons for the differential effects were discussed as was the relevance of combining metabolic reprogramming approaches to combat viral inflammatory lesions.

Granulomatous reaction as a postherpetic isotopic response after primary varicella infection in a healthy adult

We report the first case of post-herpetic isotopic reaction (PHIR) after primary varicella infection in a healthy adult. PHIR refers to the development of new skin lesions at sites where prior herpetic skin lesions have been resolved. Herpes zoster is the most common cause of PHIR; however, only a few cases of PHIR due to primary varicella infections have been reported. Postherpetic isotopic reaction (PHIR) refers to the development of new skin lesions at sites where prior herpetic skin lesions have been resolved. Herpes zoster (HZ) is the most common cause of PHIR; however, only a few cases of PHIR due to primary varicella infections have been reported. A 22-year-old Japanese man with no relevant medical history presented with multiple vesicles throughout the body. The patient was diagnosed with primary varicella infection based on a positive Tzanck test. Three weeks after onset, new skin eruptions appeared in the regions affected by the primary rash. He had multiple nodules of 5–8 mm size and hues ranging from red to normal skin on his face, trunk, and limbs (Figure 1A,B). He had been vaccinated against varicella during childhood. No abnormal findings were observed except for slightly low immunoglobulin (Ig) A and IgG (IgM: 37 mg/dL, IgA: 63 mg/dL, IgG: 734 mg/dL) in blood tests. Viral antibody examination revealed varicella-zoster virus (VZV)-IgM enzyme-linked immunosorbent assay (EIA) and VZV-IgG EIA titers of 0.03 and 6.8, respectively (both tests are positive at ≥4.0), indicating a previous infection. Histological findings showed epithelioid cells and granulomatous foreign body giant cells within the upper dermis, surrounded by marked neutrophilic and lymphocytic infiltration. No caseous necrosis, inclusion bodies, or residual viral particles were observed (Figure 1C,D). The patient was diagnosed with granulomatous reaction as PHIR after primary varicella infection. The nodules gradually improved with topical steroid, and no recurrence was noted. Postherpetic isotopic reaction is a type of Wolf's isotope reaction (WIR), and some argue that WIRs are Koebner reactions.1 However, Koebner reactions generally indicate the appearance of the same preexisting dermatosis on the injured skin. In the present case, a completely different eruption appeared after the primary rash. Thus, it was appropriate to describe it as a PHIR. Various skin manifestations have been reported in PHIR, with granulomatous dermatitis being the most common. According to Wang et al., the pathogenesis of granulomatous reaction as PHIR possibly encompasses post-infection nerve damage and residual virus particles, which may induce secretion of interleukin-4 and other chemokines, promote infiltration of inflammatory cells, and locally modulate immune and angiogenic responses.2 Less nerve damage associated with primary varicella compared to that associated with HZ may be a reason for the infrequent PHIR phenomenon following primary varicella infection. Several pediatric cases of granulomatous reactions as PHIR after primary varicella have been reported previously.3-6 Two PHIR cases in adults were previously reported, but the patients were immunosuppressed hosts with myelogenous leukemia. Immunocompromised patients are susceptible to greater nerve damage by VZV.7 This is the first case of PHIR after varicella infection in a healthy adult. Histological findings supported the possibility of a hyperimmune response to residual viral particles, resulting in granulomatous dermatitis. Blood samples showed a slightly low level of immunoglobulins, but no other abnormalities were observed. Although the cause is unclear, the patient should be followed carefully for the future development of immune system diseases. Further studies are required to understand the mechanisms underlying PHIR after varicella infection. The authors declare no conflict of interest. Informed consent: Informed consent was provided by the patient, and approval was received. Approval of the research protocol: N/A. Registration No. of the study/trial: N/A. Animal studies: N/A. The data that support the findings of this study are available from the corresponding author, Y. W., upon reasonable request.

Recurrent Herpes Infection in Two Cases with Chronic Myeloid Leukemia Using Dasatinib

Viral infections especially herpes virus and varicella zoster virus are common complications in patients with hematologic malignancies. The spectrum of infectious complications during and after dasatinib therapy are not known. I report here recurrent herpes labialis and herpes zoster infections in two chronic myeloid leukemia cases treated with dasatinib.

Interesting Case of Disseminated Herpes Infection in A Healthy Female Patient Resembling Monkeypox

Normally we find cases of disseminated cutaneous herpes-simplex in immunocompromised individuals. With the advent of monkeypox, many reports have been falsely purporting cases of this disease when the lesions were either herpes simplex or an unspecified skin infection. In this case report we document the finding of a healthy 31-year-old female with herpetic lesions on her arms, legs, and vulvar area.

Herpes Simplex (Cold Sores)—Child Care and Schools

Herpes Simplex (Cold Sores)—Child Care and Schools

Prevalence of Herpes Simplex Virus Type-2 IgG Antibody among pregnant women in Port-Harcourt, Nigeria

Background and Aims: Herpes Simplex Type 2 Viruses (HSV- 2) are one of the most common viral sexually transmitted diseases worldwide, which are now a significant health concern. The most significant incidence of HSV infections occurs in women of reproductive age. Thus, the study aimed to ascertain the occurrence of HSV-2 IgG in pregnant women in Port Harcourt, Nigeria and identify the demographic profile associated with the prevalence. Materials and Methods: A hospital-based cross-sectional survey was adopted to randomly analyze 90 pregnant women attending antenatal clinics at a tertiary hospital in Port Harcourt, Nigeria. An enzyme-linked immunosorbent assay was used to assess HSV-2 IgG antibodies in the samples obtained. Results: Of the 90 subjects, 51.1% were HSV-2 seropositive, while 48.9% were seronegative for HSV-2 IgG antibody. No statistical association existed between the prevalence of HSV-2 IgG antibodies and the sociodemographic factors studied (p&gt;0.05). Higher prevalence of HSV-2 IgG antibody mostly occurred in age 20-29 (54.2%), married (51.7%), no formal education (100.0%), unemployed and artisans (75.0%), Christians (53.1%), monogamous family type (52.0%), first trimester (62.5%), nulliparous (67.6%), abortion history (66.7%), history of Sexually Transmitted Diseases (STDs) (83.3%) and Human Immunodeficiency Virus (HIV) seropositive (100.0%). Conclusions: This study has confirmed that the prevalence of HSV-2 IgG antibodies among pregnant women in Port Harcourt, Nigeria is very high. The results indicate a considerable risk of primary or recurrent HSV infection during pregnancy, as shown by the prevalence rates. Identifying those at the highest risk is an appropriate initial step before the design of intervention strategies. Consequently, intervention strategies will be harnessed and implemented to reduce the risk of transmission to the fetus or newborn.

Mucocutaneous Manifestations in Kidney Transplant Patients: Risk Factors.

Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective analytical study (January 2020- June 2021) including kidney transplant patients seen at the Nephrology Department.We described the characteristics of the patients who presented mucocutaneous complications and then compared them to those who didn't to deduce the risk factors.Statistical analysis was performed using SPSS 20.0 (p<0.05). Results Of the 86 patients recruited, thirty patients had mucocutaneous complications. The mean age was 42.73, with a male predominance (73%). Ten kidney transplants were performed from a living-related donor. All the patients received corticosteroids, Mycophenolate Mofetil, and the Calcineurin Inhibitor: Tacrolimus (76.7%) or Ciclosporin (23.3%). Induction was performed with Thymoglobulin (n=20) or Basiliximab (n=10). Mucocutaneous complications were dominated by infectious manifestations (53.4%): eight cases of fungal infections; six cases of viral infections: warts (n=3), herpes labialis (n=2), intercostal herpes zoster (n=1), and two cases of bacterial infections: atypical mycobacteria and boils. Inflammatory complications (36.6%) included acne (n=4), urticaria (n=3), rosacea (n=1), simple maculopapular exanthema (n=1), aphthous lesion (n=1), and black hairy tongue (n=1). Actinic keratosis, skin xerosis, and bruises were found in one patient respectively. The evolution with a symptomatic treatment was good in all the patients.After statistical analysis, the factors significantly associated with the occurrence of mucocutaneous complications were advanced age, male gender, anemia, HLA non-identical donor, as well as the use of Tacrolimus or Thymoglobulin. Conclusion Infectious mucocutaneous complications are the most common dermatological manifestations among renal transplant recipients. Their occurrence is related to advanced age, male gender, anemia, HLA non-identical donor, and the use of Tacrolimus or Thymoglobulin.

Role of Innate Interferon Responses at the Ocular Surface in Herpes Simplex Virus-1-Induced Herpetic Stromal Keratitis.

Herpes simplex virus type 1 (HSV-1) is a highly successful pathogen that primarily infects epithelial cells of the orofacial mucosa. After initial lytic replication, HSV-1 enters sensory neurons and undergoes lifelong latency in the trigeminal ganglion (TG). Reactivation from latency occurs throughout the host's life and is more common in people with a compromised immune system. HSV-1 causes various diseases depending on the site of lytic HSV-1 replication. These include herpes labialis, herpetic stromal keratitis (HSK), meningitis, and herpes simplex encephalitis (HSE). HSK is an immunopathological condition and is usually the consequence of HSV-1 reactivation, anterograde transport to the corneal surface, lytic replication in the epithelial cells, and activation of the host's innate and adaptive immune responses in the cornea. HSV-1 is recognized by cell surface, endosomal, and cytoplasmic pattern recognition receptors (PRRs) and activates innate immune responses that include interferons (IFNs), chemokine and cytokine production, as well as the recruitment of inflammatory cells to the site of replication. In the cornea, HSV-1 replication promotes type I (IFN-α/β) and type III (IFN-λ) IFN production. This review summarizes our current understanding of HSV-1 recognition by PRRs and innate IFN-mediated antiviral immunity during HSV-1 infection of the cornea. We also discuss the immunopathogenesis of HSK, current HSK therapeutics and challenges, proposed experimental approaches, and benefits of promoting local IFN-λ responses.

Efficacy and safety of baricitinib treatment for moderate to severe atopic dermatitis in real-world practice in Japan.

The authors evaluated the efficacy and safety of baricitinib, a Janus kinase 1/2 inhibitor, for atopic dermatitis (AD) in real-world practice. From August 2021 to September 2022, 36 patients aged ≥15 years with moderate to severe AD were treated with oral baricitinib 4mg/day plus topical corticosteroids. Baricitinib improved clinical indexes; the percent reduction at weeks 4 and 12 was a median of 69.19% and 69.98% for the Eczema Area and Severity Index (EASI), 84.52% and 76.33% for the Atopic Dermatitis Control Tool, and 76.39% and 64.58% for Peak Pruritus Numerical Rating Score, respectively. The achievement rate of EASI 75 was 38.89% and 33.33% at weeks 4 and 12, respectively. The percent reduction of EASI in the head and neck, upper limbs, lower limbs, and trunk was 56.9%, 68.3%, 80.7%, and 62.5% at week 12, respectively, with a significant difference between the head and neck versus the lower limbs. Baricitinib decreased thymus and activation-regulated chemokine, lactate dehydrogenase, and total eosinophil count at week 4. Baseline EASI of the head and neck negatively correlated with percent reduction of EASI at week 4, while baseline EASI of the lower limbs positively correlated with percent reduction of EASI at week 12. Treatment-emergent adverse events included elevation of creatine phosphokinase (11.1%), herpes labialis (5.6%), furuncle (8.3%), and exacerbation of AD (1%), without serious treatment-emergent adverse events. In this real-world study, baricitinib was well tolerated for patients with AD and achieved therapeutic effects comparable to those in clinical trials. High baseline EASI of the lower limbs might predict good treatment response at week 12, while high baseline EASI of the head and neck might predict poor treatment response at week 4 in baricitinib treatment for AD.

COMPARATIVE EFFICACY OF ANTIVIRAL AGENTS FOR PREVENTION AND MANAGEMENT OF HERPES LABIALIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS.

To compare the relative efficacy and safety of antiviral agents used in the prevention and management of herpes labialis through a network meta-analysis of clinical trials. A systematic search was performed in Ovid Medline PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Clinicaltrials.gov for randomized controlled trials (RCTs) reporting a comparison of antiviral agents in the management and prevention of herpes labialis in healthy/immunocompetent adults. The data extracted from the selected RCTs were assessed and a network meta-analysis (NMA) was performed. The interventions were ranked according to the surface under the cumulative ranking (SUCRA). A total of 52 articles were included for qualitative synthesis and for the quantitative part, 26 articles were analyzed for the primary treatment outcome and 7 studies were analyzed for the primary prevention outcome. The combination therapy of oral valacyclovir and topical clobetasol was the best ranked with a mean reduction in healing time of -3.50 (95% CI -5.22 to -1.78) followed by vidarabine monophosphate of -3.22 (95% CI -4.59 to -1.85). No significant inconsistencies, heterogeneity, and publication bias were reported for TTH outcome analysis. For primary prevention outcomes, only 7 RCTs fulfilled the inclusion criteria, and none of the interventions was shown to be superior to each other. The absence of adverse events was reported by 16 studies, whereas other studies reported mild side effects only. NMA highlighted that several agents were effective in the management of herpes labialis among which the combination of oral valacyclovir with topical clobetasol therapy was the most effective in reducing the time to heal. However, further studies are required to determine which intervention is the most effective in preventing the recurrence of herpes labialis.

Chronic recurrent urticaria in a patient with recurrent herpes labialis: complete remission after administration of aciclovir and antihistamines.

Chronic recurrent urticaria, occurring in the context of infections, represents a major challenge for clinicians. Chronic genital herpes infection has been perceived in the literature as a possible trigger of chronic recurrent urticaria. The administration of a systemic corticosteroid regimen in these cases has no long-lasting effect and the subsequent relapses are difficult to control. In these cases, treatment of the urticaria with antihistamine (as monomedication) is often not sufficient and does not suppress the symptomatology. The administration of acyclovir or valacyclovir according to a specific therapeutic regimen as monotherapy or in combination with antihistamine has been shown to be quite effective. The doses of this administration vary and can be tailored to clinical symptomatology. We present a 41-year-old female patient with chronic recurrent urticaria associated with angioedema and bronchospasm, in whom her herpes genitalis was found to be concurrent within the history and clinical examination. According to the history, the herpes was also recurrent and dated back about a year. Chlamydia trachomatis infection was also found, with serological findings corresponding to vaginal discomfort. Treatment with acyclovir 400mg thrice daily for an initial period of 7 days in combination with desloratadine 5mg daily was started as we observed complete remission of the urticarial rash. Due to worsening vaginal discharge, it was decided to temporarily discontinue systemic acyclovir therapy and treatment for the chlamydial infection was initiated with doxycycline 100 mg twice daily for 21 days. Already on day 1 after stopping acyclovir, a severe relapse with generalization of the urticarial rash was observed. Control of symptomatology was achieved by reintroduction of acyclovir according to the regimen in combination with antihistamine. Chronic infections are one of the common causes of chronic recurrent urticaria with a tendency to generalization and possible complications such as angioedema and bronchospasm. An academic, analytical approach to patients and the consistent exclusion of each possible trigger for chronic recurrent urticaria often guarantee the success of subsequent treatment.